Alteplase vs. Dual Antiplatelet Therapy For Mild Non-disabling Stroke

20 Jul 2023 • Excellent outcomes were seen with dual antiplatelet therapy. Thrombolytic medications have comparable benefits to aspirin for nondisabling mild strokes in terms of recurrent stroke prevention but have increased bleeding risk. Dual antiplatelet therapy (DAPT) has been shown to reduce recurrent stroke risk more than aspirin alone in these patients.

  • During the 3.5-year study period, 719 patients with a mean age of 64 years (31% women) were enrolled. The median NIH stroke scale score was 2, and patients received treatment within an average of 3 hours following symptom onset.
  • The DAPT group received a loading dose of clopidogrel (300 mg) followed by daily 75 mg for 12 days, along with 100 mg of aspirin daily for 12 days.
  • Alteplase was administered in the standard manner.
  • Both groups received guideline-based antiplatelet therapy for 90 days.
  • The primary outcome of achieving excellent neurologic status at 90 days was observed in 93.8% of the DAPT group and 91.4% of the alteplase group, confirming the noninferiority of DAPT.
  • The rate of sICH was low in both groups (0.3% for DAPT and 0.9% for alteplase). The rate of any bleeding event was lower with DAPT compared to alteplase (1.6% vs. 5.4%). Mortality at 90 days was low in both groups, as expected in a mild-stroke population (less than 1% in both groups).

In summary, the study demonstrated that DAPT with aspirin plus clopidogrel was noninferior to alteplase in achieving excellent neurologic status at 90 days in patients with mild stroke. DAPT had a lower rate of bleeding events compared to alteplase. These findings suggest that DAPT may be a suitable alternative to alteplase in selected patients with mild strokes.

Source: J Watch | Read full story

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